Provider Demographics
NPI:1619074077
Name:SULLIVAN, KERRIE L (RN CFNP MSN)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:L
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RN CFNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BESTGATE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3371
Mailing Address - Country:US
Mailing Address - Phone:410-266-2720
Mailing Address - Fax:410-224-0209
Practice Address - Street 1:1000 BESTGATE RD STE 400
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-2720
Practice Address - Fax:410-224-0209
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD88989506OtherBCBS
DCW8490005OtherBCBS
J4570008OtherBCBS DC
MD411894400Medicaid
MD88989504OtherBCBS
MD88989507OtherBCBS
DCD3800008OtherBCBS
88989503OtherBCBS MD
DCW8490005OtherBCBS
MD411894400Medicaid